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4th yr- CMS- drugs and medication > nitrous oxide and carbamazepine > Flashcards

nitrous oxide and carbamazepine Flashcards

1
Q

What is nitrous oxide also known as

A

Laughing gas

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2
Q

Why is nitrous oxide used in dentistry

A

Used fro inhalation sedation in children and adult patients

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3
Q

What properties does nitrous oxide have

A

It has anaesthetic and analgesic properties

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4
Q

What effect does nitrous oxide have on the bodys reaction time

A

Slows down reaction time

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5
Q

What does the mechanism of action of nitrous oxide

A

May involve NMDA glutamate receptor blockade so produce its general anaesthesia effect

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6
Q

What effect can nitrous oxide have on opioid receptors

A

has the potential to stimulate opioid receptors to produce analgesia

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7
Q

What effect can long term arise of nitrous oxide have on the body

A

May megaloblastic anaemia and spinal cord degeneration

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8
Q

Describe the pharmacokinetics of nitrous oxide

A

Nitrous oxide is more soluble in water than nitrogen on its own is

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9
Q

Where is nitrous oxide preferably exchanged

A

Exchanged at the alveolar membranes of the lungs and readily enters the bloodstream to exert its effect

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10
Q

How can nitrous oxide affect respiration

A
  1. Reduced total volume

2. Increases respiratory rate

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11
Q

How can nitrous oxide affect on the heart

A

Mild effects on heart rate and pulmonary vascular resistance

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12
Q

How can nitrous oxide affect the renal and hepatic system

A

Reduced renal and hepatic blood flow

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13
Q

How can nitrous oxide affection on blood flow

A

Increases cerebral blood flow metabolism and intracranial pressure

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14
Q

What can carbamazepine be used for

A
  1. Anti-epileptic drug/anticonvulsant
  2. Neuropathic pain
  3. Bipolar disorder
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15
Q

Describe the pharmacodynamics of carbamazepine

A

Sodium channel blockade treats seizures

Narrow therapeutic index

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16
Q

What is the mechanism of action of carbamazepine

A
  1. Reduces excitability of neurones by sodium channel blockade
  2. Lowers presynaptic nerve response and inhibits post synaptic potential
  3. Binds to voltage-gated sodium channels and prevents action potentials firing
17
Q

What can carbamazepine do in bipolar disorder

A

It increases metabolism of dopamine and increases transmission of GABA to treat mania an depressive symptoms

18
Q

What is carbamazepine known as

A

Enzyme inducer

19
Q

What do we mean by enzyme inducer

A

Means it potently induces the pathways of metabolism of numerous other drugs
this mean the second drug may have a lower effective dose

20
Q

what should we do if carbamazepine is administrated with another drug

A

We may need to increase the dose of the other drug which may have metabolised due to carbamazepine

21
Q

Where is carbamazepine metabolised

A

by the liver through the CYP P450 pathway

22
Q

What happens to carbamazepine in the liver

A

Undergoes hepatic glucuronidation resulting in minor hydroxy metabolites and quinone metabolites

23
Q

What induces carbamazepine metabolism and what does this mean

A

carbamazepine induces its own metabolism leading to enhanced clearance, reduced half-life and reduced serum levels

24
Q

What is the half life of carbamazepine

A

12-17 hours

25
Q

What are the common side effects of carbamazepine

A
  1. Drowsiness,
  2. dizziness,
  3. headaches,
  4. nausea,
  5. double vision,
  6. unsteadiness,
  7. memory/ concentration difficulties
26
Q

What are the contra indications of carbamazepine

A
  1. Allergy
    2, Heart disease
  2. Porphyria
  3. Bone marrow disorders
27
Q

In whom should we be cautious prescribing carbamazepine

A

Patients with:

  1. Cardiac disease
  2. Hx of haematological reactions to other drugs
  3. Absence/myoclonic seizures
  4. History of skin reactions
  5. Angle-closure glaucoma
28
Q

What are the serious side effects of carbamazepine

A
  1. Agranulocytosis (rare/very rare)
    2, Steven- Johnson syndrom e
  2. Unusual bleeding/ bruising with mouth ulcers, high temp or sore throat
  3. Suicidal ideation/ psychosis
  4. Jaundice
  5. Muscle and joint pain, molar rash, breathing difficulties
29
Q

Should we prescribe carbamazepine in pregnancy patients

A

yes we can

30
Q

What can carbamazepine interact with

A
  1. Anticoagulants- warfarin, NOACs
  2. Antibiotics- clarithromycin, erythromycin
  3. Antifungals -fluconazole
  4. Antidepressants
  5. Cyclosporine
  6. HIV medication
  7. MAOIs
  8. St johns wort
  9. Alcohol

4th yr- CMS- drugs and medication (4 decks)

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